Transplantation of organs and tissues has saved the lives of thousands of patients with life-threatening organ failure and improved the general quality of life for thousands more. However, the number of individuals able to benefit from these procedures is limited by ineffective efforts to procure available organs and tissues. Recently, in an effort to increase organ and tissue procurement, legislation has been passed requiring that hospitals develop policies to ensure discussion about donation with families of deceased patients. However, it has been estimated that rates of compliance do not exceed 50 percent in most states and that large variations in hospital and health care professional ability to procure organs and tissues exist. Despite fifteen years of research, the exact reasons for the flaws in the procurement process are still not well understood. This three year multi-site study will examine the legal, organizational, and health care professional variables which effect the donation process by identifying a case series of donor eligible patient deaths through weekly record reviews of patient deaths in 22 hospitals in the Pittsburgh and Minneapolis-St. Paul Standard Metropolitan Statistical Areas. We expect to review 9,022 records, accruing 253 eligible organ donors, 1,010 eligible tissue donors, and 1,705 eligible cornea donors. For each patient case we will identify the health care professionals who cared for the patient at the time of death and schedule a directed interview to obtain data about what actually occurs when a patient, eligible to donate organs or tissues, dies, and to elicit health care professionals' attitudes and knowledge about the donation process. To determine hospitals' policies and their efforts to encourage procurement, the hospital administrator responsible for donation will be interviewed. Findings from this study will provide detailed information regarding the importance of organizational, cognitive, attitudinal, and behavioral factors in the procurement process. These findings can help suggest the most effective ways to enhance procurement, thus increasing the number of individuals who can benefit from transplantation.